Neonatal sepsis

Neonatal sepsis is a blood infection that occurs in an infant younger than 90 days old. Early-onset sepsis is seen in the first week of life occurs after 1 week and before 3 months of age.

Causes

Neonatal sepsis can be caused by bacteria such as Escherichia coli (E.coli), Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. However, this problem has become less common because women are screened during pregnancy. The herpes simplex virus (HSV) can also cause a severe infection in a newborn baby. This happens most often when the mother is newly infected.

Early-onset neonatal sepsis most often appears within 24 hours of birth. The baby gets the infection from the mother before or during delivery. The following increase an infant's risk of early-onset bacterial sepsis:

GBS colonization during pregnancy

Preterm delivery

Water breaking (rupture of membranes) longer than 18 hours before birth

Infection of the placenta tissues and amniotic fluid (chorioamnionitis)

Babies with late-onset neonatal sepsis are infected after delivery. The following increase an infant's risk of sepsis after delivery:

Having a catheter in a blood vessel for a long time

Staying in the hospital for an extended period of time

Symptoms

Infants with neonatal sepsis may have the following symptoms:

Body temperature changes

Breathing problems

Diarrhea or decreased bowel movements

Low blood sugar

Reduced movements

Reduced sucking

Seizures

Slow or fast heart rate

Swollen belly area

Vomiting

Yellow skin and whites of the eyes (jaundice)

Exams and Tests

Lab tests can help diagnose neonatal sepsis and identify the cause of the infection. Blood tests may include:

Blood culture

C-reactive protein

Complete blood count (CBC)

If a baby has symptoms of sepsis, a lumbar puncture (spinal tap) will be done to look at the spinal fluid for bacteria. Skin, stool, and urine cultures may be done for herpes virus, especially if the mother has a history of infection.

A chest x-ray will be done if the baby has a cough or problems breathing.

Urine culture tests are done in babies older than a few days.

Treatment

Babies younger than 4 weeks old who have fever or other signs of infection are started on intravenous (IV) antibiotics right away. (It may take 24 to 72 hours to get lab results.) Newborns whose mothers had chorioamnionitis or who may be at high risk for other reasons will also get IV antibiotics at first, even if they have no symptoms.

The baby will get antibiotics for up to 3 weeks if bacteria are found in the blood or spinal fluid. Treatment will be shorter if no bacteria are found.

An antiviral medicine called acyclovir will be used for infections that may be caused by HSV. Older babies who have normal lab results and have only a fever may not be given antibiotics. Instead, the child may be able to leave the hospital and come back for checkups.

Babies who need treatment and have already gone home after birth will most often be admitted to the hospital for monitoring.

Outlook (Prognosis)

Many babies with bacterial infections will recover completely and have no other problems. However, neonatal sepsis is a leading cause of infant death. The more quickly an infant gets treatment, the better the outcome.

Possible Complications

Complications may include:

Disability

Death

When to Contact a Medical Professional

Seek medical help right away for an infant that shows symptoms of neonatal sepsis.

Prevention

Pregnant women may need preventive antibiotics if they have:

Chorioamnionitis

Group B strep colonization

Given birth in the past to a baby with sepsis caused by bacteria

Other things that can help prevent sepsis include:

Preventing and treating infections in mothers, including HSV

Providing a clean place for birth

Delivering the baby within 12 to 24 hours of when the membranes break (Cesarean delivery should be done in women within 4 to 6 hours or sooner of membranes breaking.)

Alternative Names

Sepsis neonatorum; Neonatal septicemia; Sepsis - infant

References

American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Policy Statement: Recommendations for the Prevention of Perinatal Group B Streptococcal (GBS) Disease. Pediatrics. 2011:128(3):611-6. PMID: 21807694 www.ncbi.nlm.nih.gov/pubmed/21807694.

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